Committing to Child Survival - A Promise Renewed - ending - - PowerPoint PPT Presentation

Committing to Child Survival - A Promise Renewed - ending preventable child deaths

Addis Ababa, 16 January 2013

• Dr. Mickey Chopra, Associate Director Health, UNICEF

Key Messages

• Globally and in Africa we are making progress
• However for too many women and children

and some conditions progress is too slow

• The ambition of A Promise Renewed for Africa
• The immediate challenges for accelerating

progress

The global burden of under-five deaths has fallen steadily since 1990

Global number of under-five deaths, selected years 12.0 10.8 9.6 8.2 6.9 2 4 6 8 10 12 14 1990 1995 2000 2005 2011

Millions of under-five deaths Source: The UN Inter-agency Group for Child Mortality Estimation, 2012; provided by SMS/DPS/UNICEF

The global under-five mortality rate has fallen by 41% from 1990 to 2011

Under-five and neonatal mortality rate, 1990-2010

Source: The UN Inter-agency Group for Child Mortality Estimation, 2012; provided by SMS/DPS/UNICEF

87 51 MDG Target: 29 32 22 10 20 30 40 50 60 70 80 90 100 1990 1995 2000 2005 2010 2015

Deaths per 1,000 live births

U5MR NMR

20 40 60 80

1990 1995 2000 2005 2010 2015 2020 2025 2030 2035

Source: UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011; UNICEF, Required Acceleration for Child Mortality Reduction beyond 2015, 2012; team analysis Save the Children team analysis for NMR projection

Mortality Rate (deaths / 1000 births)

20 35 Accelerated U5MR ARR = 5.1% Current U5MR ARR = 2.2%

* ARR = annual rate of reduction

MDG 4 target = 34 U5MR

Global Progress for child survival

U5MR and NMR decline 1990-2010, projected to 2035

15 Current NMR ARR = 1.8%

If 1-59 month mortality accelerates further but neonatal mortality continues on same trend then with 2 million child deaths in 2035, 1.5 million may be neonatal.

All regions have experienced marked declines in under-five mortality rates since 1990

Deaths per 1,000 live births

Source: IGME 2012

The global burden of under-five deaths is increasingly concentrated in Sub-Saharan Africa

Share of under-five deaths, by region, 1990-2010 (%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1990 1995 2000 2005 2010

Sub-Saharan Africa South Asia East Asia and Pacific Middle East and North Africa Latin America and Caribbean CEE/CIS Industrialized countries

Source: IGME 2011

1) Sierra Leone(185 per 1000 live births) 2) Somalia 3) Mali 4) Chad 5) Democratic Republic of the Congo 6) Central African Republic 7) Guinea-Bissau 8) Angola 9) Burkina Faso 10) Burundi 11) Cameroon 12) Guinea 13) Niger 14) Nigeria 15) South Sudan 16) Equatorial Guinea 17) Mauritania 18) Togo 19) Benin 20) Swaziland (104 per 1000 live births)

Source for mortality rank: UN Inter-agency Group for Child Mortality Estimation 2012; Fragile Situation countries are shown in red (source: World Bank 2011)

In 2011, for the first time, the 20 countries with the highest under child mortality rates are all in Africa. There is a strong correlation between conflict, ‘fragile situations’ and child mortality rates.

8

Top 10 countries in Africa with the largest reductions in child mortality, 2000-2011

Ran k Country Annual rate of reduction (%) 1. Senegal 6.4% 2. Malawi 6.2% 3. Zambia 5.6% 4. Ethiopia 5.3% 5. Namibia 5.2% 6. Niger 5.0% 7. Morocco 4.3% 8. Zimbabwe 4.1% 9. Kenya 4.0% 10. Nigeria 3.8%

170 Governments Pledged to date

Including 48 of the 54 countries in Africa plus hundreds of

• Civil Society organisations, Faith Based
• rganisations, Individuals, schools and

workplaces

• Focus on results and accountability
• But also an important technical component

www.apromiserenewed.org

20 by 2035: selected country U5MR trajectories

20 40 60 80 100 120 140 160 180 200 220 240 260 280 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035

Under-five mortality rate (deaths per 1,000 live births)

Mali continuation of 2000-2010 trend Mali to reach 20 by 2035 Democratic Republic of the Congo Côte d'Ivoire Lesotho India Indonesia Peru

0% 25% 50% 75% 100%

COMMODITIES: % health centres with no perinatal supply stock-outs HUMAN RES: % facilities with sufficient workers ACCESS: % families living near health facility with daily service provision UTILISATION: % deliveries assisted by trained worker CONTINUITY: % deliveries with i) SBA ii) weighed & iii) receive 3 postnatal care visits EFFECTIVE COV: % of SBA deliveries occur within a ANC- qualified health facility

Most Deprived Least deprived Supply Bottlenecks

> 20% difference in availability and accessibility to facilities with SBA

Demand Bottlenecks

(esp. Financial access) in most deprived but least deprived tend to use even more than what is available

Changing How We Do It: Supply and demand

bottlenecks for most / least deprived areas analyzed

Major bottlenecks to achieving results

• Decentralization & Low capacity: weak supervision,

management, QA and motivation

• Major barriers to access: poor enforcement of pro-poor cash

transfers and fee-waivers

• Incomplete uptake of life-saving interventions: e.g. zinc for

diarrhea

• Ineffective resource management: especially in decentralized

settings

• Structural barriers: economic, political, socio-cultural

Potential approach Description Possible strategies Shift intervention within channel Shift intervention to different delivery channel Improve performance of delivery channel

Shift existing within channel New delivery or technology approach Improve channel performance Change way of delivering interventions within existing channels Task shifting among different cadres of workers Improving outreach services (including specialist outreach) Shifting to different sets of providers through public-private partnerships, contracting out, or franchising Deliver the intervention through a better performing channel Task shifting from clinic-based to community-based Shifting interventions from clinic- based to child health campaigns Shifting behaviour change counselling from face to face to social marketing or implementing policy changes Improve efficiency, capacity and accessibility of delivery channel Human resources availability: Compulsory service, Hardship allowances, retention of HR in rural settings… Geographic access: Increase number of service points Financial access: User fee abolitions, Insurance schemes, Conditional cash transfers, Vouchers Continuity: PBI, remuneration (salaries) Defaulter tracking Quality: Supervision/mentoring, training, audits, accreditation… Demand: Community/individual empowerment, social marketing…

THANK YOU !

16